Anthem Blue Cross patients of two San Fernando Valley hospitals may have to switch hospitals or cough up higher out-of-network fees after the two sides terminated their contract earlier this month.
The decision means Anthem patients will no longer pay in-network rates if they wish to be treated at Los Robles Hospital & Medical Center in Thousand Oaks and West Hills Hospital and Medical Center in West Hills. Both hospitals are owned by Nashville based HCA.
There is, however, an agreement in place at both hospitals under which certain patients can continue to be treated at network rates. And Beverly Gilmore, CEO of West Hills Hospital said she expects the parties to resolve their differences soon.
“Blue Cross is an important partner for us and it’s important to us to get this resolved,” she said.
HCA terminated talks with Blue Cross on March 3 after months of negotiations over pricing. Both local hospitals said of all payers with which they contract, Blue Cross is their lowest payer.
Blue Cross spokesman Darrel Ng said the previous contract had given HCA cumulative increases of 75 percent since 2006, which allowed the corporation to earn a profit margin of 35 percent.
“We are disappointed that HCA has decided to terminate its relationship with Anthem Blue Cross,” he said. He added that Anthem “remains available and open to continuing dialogue with HCA.”
Los Robles Hospital and Medical Center in Thousand Oaks expressed disappointment that the insurance company was unwilling to pay the hospital more for services given what it said were average recent health insurance premium increases of 9.6 percent to 13.8 percent.
The hospitals both have an agreement in place to offer in-network rates to patients who have an acute condition, a serious chronic illness or a terminal illness. The hospitals will also extend the same terms to pregnant women and children under three. In addition, if Blue Cross has already authorized a procedure, the hospitals will extend in-network terms for those procedures.
The hospitals will always treat emergency situations, regardless of the contract status between the parties.
Because insurance plans can very, West Hills Hospital has set up a special phone line for patients to call.